ACA repeal with no new plan could hurt Wayne County

With the new administration's rush to repeal the Affordable Care Act and with no real plan to replace it, some residents in Wayne County are clamoring to purchase affordable health coverage before it is out of their reach.

The deadline to purchase coverage under the current guidelines is Jan. 31.

After that, should the ACA be repealed, a major concern for consumers is the potential loss of patient protections such as prohibitions on disqualifying patients from obtaining coverage based on pre-existing conditions.

Craig said the hospital's bad debt and charity combined have declined over the last three years as a result of more people having insurance. Without the ACA, or a suitable replacement, the hospital will likely see an increase in patients seeking treatment who do not have insurance.

"Some uninsured residents of Wayne County are out of the work force, between 55 and 65, and private health insurance is out of reach," Craig said.

"But they have medical needs. So these are the people who are signing up. The younger uninsured people are not worried about their health at this point, so they sign up less. They don't like the tax penalty though, and for some of them, it makes sense to go ahead and get covered."

At a recent event held in Goldsboro ---- put on by N.C. Get Covered, a state-wide coalition of organizations designed to help underserved populations acquire health coverage ---- spokesman Joe Langley urged citizens who do not already have coverage to get insured while they still can.

About 60 people attended the N.C. Get Covered event Jan. 21, at Wayne Memorial Hospital.

"A lot of people are concerned they won't be able to get coverage if not they don't already have some in place."

Langley said enrollment assistance is one of his organization's largest functions, and the sign-up programs have been highly successful.

"This group is very successful in getting the word out," he said. "That was part of the group effort, to get out the word, and there have been annual enrollment events. They explain to people what the coverage options are and how they might get covered."

Under the current system, people with pre-existing conditions cannot be excluded from purchasing insurance.

In Wayne County alone, large swaths of the population suffer from what might on the surface seem to be minor conditions, easily managed when treated. But, with the high cost of medical care and supplies these days, without insurance, those treatments are out of reach.

According to the most recent Community Health Assessment released in 2012, more than a third of the population has a pre-existing condition.

Thirty-two percent of Wayne County residents had been diagnosed with high blood pressure, which amounts to around 39,587 people. Additionally, 36.9 percent were diagnosed with high cholesterol, which is around 45,000 people. And 12.6 percent had asthma and 12 percent have been diagnosed with diabetes, which is more than 15,000 people per health condition.

The leading cause of death in Wayne County is cancer, with a total of 706 people in 2011 being diagnosed with lung, breast, prostate or colon cancers.

All these health issues qualify as pre-existing conditions, or are qualifying factors for insurance high-risk pools, which prior to the ACA resulted in higher premiums or risk for denial of coverage.

As of 2014, 17 percent of Wayne County residents were without health insurance ---- a 3 percent drop from 2011.

It was in 2014 that the pre-existing conditions protections kicked in, according to the U.S. Department of Health and Human Services office of the assistant secretary for planning and evaluation.

The ASPE credits the ACA for the nationwide drop in people who are not covered under any health insurance.

Andrew Jackson, 25, of Fremont, falls into that category. He was at Wayne Memorial Hospital Jan. 21, looking to remedy his lack of insurance during the N.C. Get Covered health insurance sign-up.

As Jackson sat in the dining room of Wayne Memorial Hospital's cafeteria and waited to speak with an enrollment specialist, he contemplated the end of the ACA and President Donald Trump's promises to repeal it.

"I don't like that," he said. "I feel like he doesn't know what he is doing, and he is going to cut a lot of people out."

Jackson said he tried last year to get health insurance, but he could not because he was unemployed at the time.

Due to the state's refusal ---- under then-Gov. Pat McCrory ---- to expand Medicaid, Jackson fell into the gap that has left many people without the ability to use the ACA's subsidies. Jackson made too little to qualify for the subsidies and did not meet the criteria for qualifying for Medicaid in the state. Had the state decided to accept the Medicaid expansion money, the criteria for Medicaid qualifications would have loosened.

The current GOP-led state legislature is now working to prevent newly-elected Gov. Roy Cooper's attempts to expand statewide Medicaid.

However, this year Jackson has a job at a daycare, and the prospects of his being able to get insurance he can afford have improved.

He said he planned to get basic coverage.

Glenn Brock, 59, is self-employed. He, too, was at the sign-up event Saturday, Jan. 21. He said he once was insured with United Healthcare, but when they pulled out of North Carolina, he had to find insurance on his own.

Brock said he thought he had found affordable coverage for himself, but when he went to the doctor's office and offered his coverage card, the doctor told him it was a discount card and not insurance at all.

Brock said he will have a Blue Cross Blue Shield plan that will go into effect in February, but his coverage could cost him up to $400 a month.

"I am here to see if I can get something better," he said with a smile.

Brock is diabetic. He said the pen he uses before he administers his diabetes medication would cost him $940 a month without insurance.

"I would have to live with diabetes (until) it kills me," he said.

For all his medication needs ---- in addition to diabetes, Jackson also suffers from high blood pressure ---- he said it would cost upward of $1,500 a month.

"Nobody can afford that," he said.

"For the most part, with my medicine, I have everything under control. My medication helps me tremendously. People that can't get this insurance, I don't know how they can afford it."

Langley said that locally, Goshen Medical Center facilitates ACA enrollment and people can go online and do it themselves.

"You can do all this on your own if you know how to get online, but some people don't own a computer or know how to use one, so they have to sit down with an enrollment specialist," he said.

To make an appointment for enrollment assistance, call 919-223-7842.

Craig and Langley alike encourage people to get covered during the ACA regular enrollment period that will end Jan. 31.

"It is always better to have insurance," Craig said. "It is just prudent."

Langley said in the uncertainty surrounding the ACA and health insurance coverage is an impetus to get enrolled.